Healthcare Provider Details

I. General information

NPI: 1629044052
Provider Name (Legal Business Name): FREDERICK HOFHEINZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD VA BUILDING 78
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

32 FELLS RD
WINCHESTER MA
01890-1438
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210057
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: